Dark Thoughts

ALIX SPIEGEL, HOST:

So we're going to start with a very simple question - what were you just thinking?

UNIDENTIFIED MAN #1: Who the hell are you? (Laughter) I mean, that's what I was just thinking.

UNIDENTIFIED GIRL #1: A cheeseburger (laughter). I wanted a cheeseburger.

UNIDENTIFIED BOY #1: Going out with my girlfriend.

SPIEGEL: You have a girlfriend?

UNIDENTIFIED BOY #1: Yep.

SPIEGEL: Really?

UNIDENTIFIED BOY #1: Yeah.

SPIEGEL: How old are you?

UNIDENTIFIED BOY #1: Eleven.

UNIDENTIFIED WOMAN #1: Whether or not this is a nice building. I'm looking to buy a condo here.

SPIEGEL: Over the last couple of months, we've been asking this question of all kinds of people.

You - you come over here.

SPIEGEL: And who are we? Well, I am Alix Spiegel.

LULU MILLER, HOST:

And I am Lulu Miller.

Can I possibly trouble you for about 30 seconds?

SPIEGEL: And I have to say - on this little thought-finding mission...

MILLER: What were you just thinking about?

SPIEGEL: ...We got just a shocking array of thoughts. We got big thoughts.

UNIDENTIFIED BOY #2: What it would be like if there was no stars, just the sun and no moon.

SPIEGEL: We got small thoughts.

UNIDENTIFIED MAN #2: How much I love this BlackBerry I'm typing on.

SPIEGEL: Musical thoughts.

UNIDENTIFIED MAN #3: I had a song in my head - (singing) smile. Oh, when your heart is aching, smile.

SPIEGEL: But also, sad thoughts.

UNIDENTIFIED WOMAN #2: I'm not good enough.

SPIEGEL: Worried thoughts.

UNIDENTIFIED WOMAN #3: I was thinking about my sister. I was thinking how I could help her.

SPIEGEL: Creepy thoughts.

UNIDENTIFIED WOMAN #4: This very vivid image of me hitting him with a hammer on his head.

SPIEGEL: So we got all kinds of thoughts.

UNIDENTIFIED GIRL #2: I'm thinking, why did you ask me what I was just thinking? What did that have to do with what you were putting on the radio?

MILLER: That's a great question, Alix.

UNIDENTIFIED GIRL #2: Yes.

SPIEGEL: Yes, it is. And the truth is that it's not just thoughts in general that we're interested in; really, it's this subset of thoughts that we want to focus on.

MILLER: Yeah, those last ones you just heard - the dark ones.

UNIDENTIFIED WOMAN #5: I'll always be alone. No one will love me.

SPIEGEL: You know these thoughts.

UNIDENTIFIED MAN #4: I'm waiting for the train, and the train is coming. And there's this moment right when the subway train's coming out of the tunnel and the lights are coming, this flicker of an impulse to just throw myself down on the tracks.

SPIEGEL: They come into our heads at random moments. Sometimes, they're kind of shocking.

UNIDENTIFIED WOMAN #6: All of a sudden, I had an image of myself strangling them.

SPIEGEL: And the thing that we want to talk about today is how should we think about these dark thoughts? You know, do they tell us something deep about ourselves, about our desires and our wishes, or not? This is INVISIBILIA. I'm Alix Spiegel.

MILLER: And I'm Lulu Miller.

SPIEGEL: And what we do on our show is we look at invisible things, stuff like ideas and emotions and beliefs and assumptions and try to understand how those invisible things are shaping our lives.

MILLER: And today, thoughts are the invisible things we are looking at.

SPIEGEL: We are a product of NPR News. And this is our very first show.

MILLER: And it is worth mentioning here that we know our voices kind of sound the same.

SPIEGEL: Yeah.

MILLER: But keep on listening, and you'll learn to differentiate us. And until then, enjoy the wash.

SPIEGEL: Right.

MILLER: Right.

SPIEGEL: Right.

MILLER: Yeah.

SPIEGEL: Yeah.

MILLER: Anyway, to this question of what to think about our thoughts, we've got two stories of two men who, for different reasons, find themselves completely overrun by dark thoughts, desperate to know the answer to the question of what to make of them. All right, Alix. You've got guy number one, right?

SPIEGEL: Yeah. Guy number one is a surfer, and to meet him, we're going to go out to the West Coast. But before we do, we should warn you that this story has some disturbing images in it. So it might not be appropriate for younger listeners. And also because some of the subject matter here is so sensitive, we're not going to use the man's real name. We're just going to use his first initial, which is S.

S: Well, come on inside.

SPIEGEL: OK. Thank you so much.

The day I met S, he answered the door in these very colorful shorts, very cheerful, very friendly. His house is just steps from the ocean.

S: The water's right here, so it's...

SPIEGEL: Oh, it's so nice. Are you, like, a surfer?

S: Yeah.

SPIEGEL: And that was the kind of life that he led - sunny, until one day, he sat down - I think it was a Friday night...

S: Friday or Saturday evening.

SPIEGEL: ...To watch a movie with his wife.

S: Relaxing, having a beer.

SPIEGEL: They were newly married. And the movie that they decided to watch was this movie called "City Of God."

S: "City Of God." It's a Brazilian movie involving the drug trafficking of Rio de Janeiro. Pretty violent movie.

SPIEGEL: It's a very violent movie.

S: The gangs would go, and they'd fight amongst each other and kill each other. And there was a lot of pretty graphic violence. And about midway through the movie, I started getting just inundated with violent thoughts. What if I were to brutally stab someone or shoot someone or harm my wife?

SPIEGEL: Now, S had never had violent thoughts like this before. And they were very disturbing - in particular, this thought about harming his new wife. But he couldn't get it out of his mind.

S: Stabbing her.

SPIEGEL: Cutting down her torso.

S: Blood and guts all over.

SPIEGEL: The thoughts became so overpowering that after the movie ended, he went into his bedroom and just curled up in a ball.

S: I put my hands over my eyes and my head and was just trying to get rid of the thoughts. But the more I tried to get rid of them, the more and more they'd come back. What if you were to murder your wife - murder your wife - murder your wife?

SPIEGEL: Eventually his wife comes in - finds him huddled there in this ball. And he didn't know what to say to her - how to put it exactly. So he just blurted out what was going through his mind.

S: I just had an image of stabbing you in the back with a knife.

UNIDENTIFIED WOMAN #7: As a new bride it was, you know, the last thing that I really thought that I would be hearing from my husband. (Laughter).

SPIEGEL: But here's the thing, his wife was completely unfazed by all this, unfazed because she felt like she knew her husband.

UNIDENTIFIED WOMAN #7: He's the coolest person I know.

SPIEGEL: They had dated for five years.

UNIDENTIFIED WOMAN #7: Gentle, sensitive, open.

SPIEGEL: So she knew what a good soul he was. He was a gentle man.

S: She said, just relax and go to sleep.

SPIEGEL: And so he went to sleep. But in the morning when he woke up, the thoughts were still there. In fact, over the next weeks and months, they just grew. It was like the movie had somehow broken open something inside of him.

S: So morning time, I would wake up and maybe the first thought in my mind was an image of stabbing an innocent person. From there, I would take a walk with my dog and, boom, there pops the thought - what if I brutally kill or rape someone and their family when their lights are on at their home?

SPIEGEL: Maybe he'd be making dinner.

S: My wife is cutting carrots for a salad. Boom - what if I grab the knife and I were to stab her?

SPIEGEL: And though he never actually acted on any of these thoughts that he was having, he was convinced that one day he might. So he started to avoid things. He wouldn't hold knives. He stopped going out with friends. But still the thoughts persisted. They were everywhere.

S: You know a chair there - inappropriately humping a chair. A pencil - using that as a weapon to stab someone.

SPIEGEL: Which meant he was having to split himself in two. For example, he works in retail, so he has to work with people all day long. So he'd have these experiences where on one level, he'd be smiling, chatting away with a customer. And on another level, he is cutting down her body with a carving knife.

S: I have to go to the bathroom - splash water on my face a lot.

SPIEGEL: That's how you would deal with it?

S: I was on the verge of just fainting. I'd go into the restroom and splash water on my face and just try to regroup.

SPIEGEL: Standing there looking in the mirror, his only explanation is that he must be having some kind of psychological breakdown.

S: Yeah, I mean, this was happening every single day.

SPIEGEL: So he and his wife turn to the Internet, searching for answers. But the things that they find there...

S: Bipolar or schizophrenic.

SPIEGEL: ...None of them seem to fit.

UNIDENTIFIED WOMAN #7: We were just so confused, so lost.

SPIEGEL: Months passed and physically, it took an incredible toll.

UNIDENTIFIED WOMAN #7: His face changed. His shoulders weren't as broad anymore.

S: 'Cause of the stress.

SPIEGEL: 'Cause he worried that if he wasn't mentally ill, there was only one horrifying conclusion - that on some level, he must want to do these things in his head.

S: There were a series of nights where I had told my wife, maybe I'm just better off if you put me in, like, the psych ward. I mean, it was kind of like, at least there, someone's there to monitor me. And I wouldn't - there's no chance of me hurting anyone.

SPIEGEL: It was around this point that S actually started thinking about killing himself. He was that scared of what he might do. He was thinking, what if he was the next Newtown killer or the next Aurora killer? And to know whether he was or he wasn't, the thing he had to understand was, what is the relationship between these thoughts and me? So finally, he decides he has to go to a therapist.

S: A psychologist or psychiatrist to get help.

SPIEGEL: But, Lulu?

MILLER: Yeah?

SPIEGEL: Here I want to put the brakes on S's story for a second because the world that S is about to encounter - the world of therapists and how they think about thoughts - it is in the middle of a huge revolution. And it's one I don't know if most people know about.

MILLER: I certainly did not until you told me.

SPIEGEL: Right. So now I need to explain the secret history of thoughts. We will return to S in good time. But I need you to come with me now on a brief tour of three phases in thought history, OK?

MILLER: OK.

SPIEGEL: And for each of these phases, we're going to visit the office of a therapist.

MILLER: All right.

SPIEGEL: So phase one, door one.

JONATHAN SHEDLER: Thoughts have meaning.

SPIEGEL: Thoughts have meaning.

SHEDLER: So every thought is the tip of an iceberg.

SPIEGEL: This is Jonathan Shedler. Shedler is a psychologist in Colorado who sees thoughts the same way that Freud proposed that we see thoughts, and because Freud was so influential, very likely the way that you see your own thoughts today, which is that your thoughts are very intimately related to who you are.

SHEDLER: And there can be a tremendous value - profound value - in understanding where they come from.

SPIEGEL: To explain, Shedler gave me this example of this patient that he saw recently, a man who, like S, was overrun with violent thoughts, but his were all about water.

SHEDLER: These gruesome images of people being waterboarded, choking and gasping for air and suffocating. And they seemed to come out of the blue. He had never had thoughts like this before. He couldn't get them out of his mind. He didn't know why they were there.

SPIEGEL: So Shedler says to this man, tell me about your thoughts. Describe them vividly. Let's explore why they are there.

SHEDLER: Let's see where your thoughts lead.

SPIEGEL: So the guy starts talking, and eventually it came up that his sister had recently died.

SHEDLER: What happened was that she was walking across a frozen lake - across the ice - and she had fallen through the ice and got trapped under the ice and drowned. And where his thoughts led were to horrific images of what the last few minutes of her life must have been like, where she was trapped under water and gasping for air. And as he talked, it became obvious to both of us that what he was describing about his sister and these gruesome images of people being waterboarded were almost identical, except he had never made the connection.

SPIEGEL: But once he did...

SHEDLER: His entire demeanor changed because all of a sudden what had been this unpleasant, inexplicable, frightening symptom all of a sudden made sense to him.

SPIEGEL: So Shedler told the man to go home, to talk to his friends and his family about his sister's death, that that would help him, and it did. The thoughts didn't come back again.

SHEDLER: So if I had told him that his thoughts had no meaning and could be ignored, I think it would have cost him down the road.

SPIEGEL: All right, so that's the traditional view of thoughts, probably how you think about your own thoughts.

MILLER: Yeah, I believe they do have some significance.

SPIEGEL: But now, my friend, it is time to mosey our way down to door number two...

MILLER: OK.

SPIEGEL: ...Because the tides have changed. And there's now a new way of thinking about thoughts that started to become popular around 1980, largely because of this man, Aaron Beck.

Yeah. All right. All right. I just need to check your levels here.

In 2004, when I was new to NPR - just a baby reporter...

MILLER: I think I can hear your pigtails.

SPIEGEL: Shut up. One of my first assignments was to go to Pennsylvania to talk to Dr. Beck.

First, tell me what you had for breakfast.

When I met him, Beck, I think, was around 80 - this kind of white-haired, old man in an Orville Redenbacher bow tie - who, like everyone else in his generation, had started his career practicing Freud's therapy, psychoanalysis.

AARON BECK: I then had a couple of experiences which made me shift gears.

SPIEGEL: You see, one day, in the late '60s, Beck was in a session with a patient - a woman who was explaining to him that several days earlier, she'd been at a party where she'd been having a difficult time connecting to people and had found herself overcome by these thoughts.

BECK: Nobody cares for me. I'm just a social outcast. Nobody will ever care for me. And she became quite sad, and she went home.

SPIEGEL: And for some reason that day, Beck did not go down the traditional path. He didn't ask the woman to follow her thought. He turned to the woman, and he asked, how do you know that those thoughts are true? Just realistically try to assess for me whether or not those thoughts bear any relationship to reality.

BECK: Explore the evidence for nobody cares for me. And she, then, could list a dozen people who obviously did care for her. And then I asked her about her being socially inept. And she was able to come up with the idea that she had been very successful socially.

SPIEGEL: Which made Beck think something - which in his world was revolutionary. Maybe people shouldn't always take their thoughts so seriously, particularly a certain subset of their thoughts.

UNIDENTIFIED WOMAN #8: I'll always be alone. No one will love me.

SPIEGEL: You remember these thoughts, right?

BECK: You are stupid.

UNIDENTIFIED WOMAN #8: I'm stupid.

BECK: They're going to dislike you.

UNIDENTIFIED WOMAN #8: I'm a failure.

BECK: And so on.

SPIEGEL: Beck had a special name for them - automatic negative thoughts.

BECK: What's interesting about the automatic thought - and this is true of everybody - is that people tend to accept them at their face value. And they don't look for alternative explanations or for what evidence is behind them.

SPIEGEL: So Beck started trying this with all of his patients. Don't trust the thought. Challenge the thought.

BECK: To test out to see whether they're really true.

SPIEGEL: And what he found was that when his patients contradicted their negative thoughts...

BECK: The patient started to get better, sooner.

SPIEGEL: Instead of it taking years, as it often did with Freudian therapy, they were getting better in a couple of months.

BECK: Oh, Dr. Beck, you've helped me a lot. And I don't think I need any more therapy.

SPIEGEL: And thus began what is now called cognitive behavioral therapy - or CBT - a new system of therapy that does not believe that the thoughts in your head are necessarily indicative of anything deep about you. And over the last 30 years, this kind of therapy has slowly but surely been displacing Freudian-based therapies. Like, Lulu...

MILLER: Mhm.

SPIEGEL: ...If you walk into a therapist's office today...

MILLER: Not that I would ever need to go to therapy.

SPIEGEL: Not that you would ever need to, but just if you did...

MILLER: Mhm.

SPIEGEL: ...Statistically speaking, you are likely walking through door number two...

MILLER: Huh.

SPIEGEL: ...Into the office of someone who does not think that your thoughts are all that important.

MILLER: So it's that popular?

SPIEGEL: Yeah, in part because a series of studies showed that CBT therapy is more effective and leads more people more quickly to mental health.

MILLER: Huh.

SPIEGEL: But we are not done yet 'cause remember - I said that there were three phases. So now allow me to open for you door number three.

(SOUNDBITE OF WAVES CRASHING)

SPIEGEL: This is the sound that greets patients in the waiting room of Miranda Morris, a therapist who practices outside Washington, D.C. And Morris practices a kind of therapy that is quietly beginning to displace CBT. It's often called third wave therapy, but it goes by other names, too, like mindfulness therapy. The premise of the therapy is that when you think about a thought as something that needs to be countered or contradicted, as CBT does, you are taking that thought way too seriously 'cause Morris believes that dark thoughts often have absolutely nothing to do with us. Our thoughts, she believes, often have no meaning at all. So instead of contradicting the negative thoughts so that they will go away, she teaches her patients, essentially, how to ignore them.

MIRANDA MORRIS: We're going to work not on getting rid of it, but on changing your relationship with it.

SPIEGEL: So how do you change your relationship with your thoughts?

MORRIS: I'll start by asking you to bring your attention to the ticking of my clocks.

(SOUNDBITE OF CLOCK TICKING)

SPIEGEL: Basically, Morris teaches her patients a stripped-down form of meditation.

MORRIS: See if you can bring your attention to the thoughts going through your mind right now.

SPIEGEL: We actually did this together in her office so that I could learn a little bit about how it works. I sat with my hands in my lap, and Morris told me to bring my attention to my thoughts - simply watch them come and go. I noticed the sound of her clocks, and I noticed an itch on my left hand. And then I noticed the sound of her clocks again. Her clocks are really, really loud.

OK, so how long would I have to do that before I started watching my thoughts?

MORRIS: You were watching. That was watching your thoughts. That's you watching your thoughts.

SPIEGEL: And how does that help me?

MORRIS: Well, I've got a metaphor. (Laughter).

SPIEGEL: OK.

Morris pulled a book from her shelf and passed it to me.

MORRIS: All right. So this book, right?

SPIEGEL: This book, she told me, represented all of the painful thoughts that I had all day long. You remember those thoughts - that you are not thin enough, that you are not smart enough, that you are too old or too young, the thoughts that quietly tell you that the path between here and there is insurmountable, and you are weak and small and not good enough. Those are the thoughts, Morris told me, that this book represented.

MORRIS: Take this and hold it on either side. Right, and I want you to hold it up to your face so that it's just about touching your nose.

SPIEGEL: And so I took the book, and I pressed it to my face - right in front of my eyes. And Morris explained that most of us walk around the world with these thoughts right in front of our eyes, in this way.

MORRIS: And how is that for you to have your painful thoughts and feelings be the primary focus of your attention?

SPIEGEL: Not so good.

MORRIS: Not so good.

SPIEGEL: I mean, the view isn't great.

When you practice meditation, Morris tells me, you learn to control where you place your attention. And when a disturbing thought comes into your brain, you learn how to just let it float by without ever engaging it. She then takes the book and gently pushes it into my lap.

MORRIS: It's still right there, but now it's not the focus of your attention.

(SOUNDBITE OF PIANO MUSIC)

SPIEGEL: That's a new way of thinking about thoughts, which, in a way, is a very old way of thinking about thoughts. The idea is you don't engage the bad ones. They don't matter that much. Just find the thoughts that are helpful, that help you to live the life that you want to live. Keep those thoughts in front of you, and the rest, just let float away. They're not you. There's no good reason to focus on them, which finally brings us back to S and the problem he had with his thoughts.

S: What if I hurt someone or kill someone? Maybe I'm just better off if you put me in, like, the psych ward.

SPIEGEL: Now, when S set off to find himself a therapist, he obviously knew nothing about this strange evolution in thinking about thinking that's gripped the world of psychotherapy. Few people do. He just made an appointment with a therapist he found online and walked through her door.

S: That first psychologist was a very bad experience.

SPIEGEL: Turned out that he had walked through door number one, into the office of a Freudian-type therapist who believed that S's thoughts were connected to something very real inside of him.

S: I think, in a way, she was kind of scared of what I was seeing - you know, the images that I was having of, you know, the killing, the raping, the maiming. And I kind of got that she may think that I would be a danger.

SPIEGEL: Which, of course, made S even more scared and more anxious and more determined to understand what was behind his horrible thoughts so that he could resolve whatever was causing them. But he really never got the opportunity to test the Freudian process properly.

S: After seeing her four or five times, I had requested another visit, and I never got a call back.

SPIEGEL: And what did that make you think?

S: That my condition was really serious and that, you know, if a therapist didn't want to see me - what, you know? Where do I go now?

SPIEGEL: S took a nosedive - retreated from the world more and more until finally he decided he didn't have a choice. He had to find another therapist. So he turned to a man he found online.

SPIEGEL: What was his name?

S: Tom.

TOM CORBOY: Tom Corboy.

SPIEGEL: We actually went to visit Tom Corboy.

CORBOY: Hello.

SPIEGEL: Hi.

He works out of a sunny, corner office in a modern, glass high-rise full of clean lines.

CORBOY: Make yourselves comfortable.

SPIEGEL: All right.

And Corboy explained to me that when someone like S walks through his door, he has a very specific therapy that he uses with them. On the third or fourth session, he hands them a knife. That's right. You heard me - hands them a knife.

That's like the "Psycho" knife.

CORBOY: It is like the "Psycho" knife.

SPIEGEL: And he tells them to hold it to his throat.

Are you kidding me?

CORBOY: Not in the slightest.

SPIEGEL: You see, Corboy is a third wave kind of guy. He runs the practice where S found a therapist, and that practice has a very strong position on thoughts, which is that most of our thoughts aren't that important.

CORBOY: Most thoughts we have are just nonsense. They're just synapses popping off in our head, and we don't need to take them all so seriously.

SPIEGEL: And according to Tom, the problem with people like S is not that they have these dark thoughts. We all have them.

CORBOY: You know, you stick me on the 405 at rush hour, it's just a matter of time before I start thinking of killing somebody.

SPIEGEL: It's S's reaction to his dark thoughts that's the problem. See, according to Corboy, S has a subset of obsessive-compulsive disorder - OCD with harming obsessions.

CORBOY: Harm OCD.

SPIEGEL: Obsessive-compulsive disorder is a thinking problem. You focus obsessively on the things that most disgust you. If you hate germs, you think continuously about germs - how they're crawling all over you. If you fear fire, you think about burning down your own house, day and night

CORBOY: It's really just a question of what they're afraid of.

SPIEGEL: So really, the real problem with S and many of the people like him - and there are plenty of them - isn't that they are less moral than the rest of us. Corboy says their problem actually is that they're more moral.

CORBOY: Their sense of moral identity is a strong part of it.

SPIEGEL: See, when most of us have these thoughts, we are unfazed by them.

CORBOY: The average person just goes, huh, silly thought, and gets on with their day. But a person with OCD has these thoughts, and they become extremely distressed.

SPIEGEL: It disgusts them that these thoughts are even in their brain.

S: What if I hurt someone or kill someone?

SPIEGEL: So when a thought like that comes into their head, they try as hard as they can to push it away, but that, it just makes the thoughts grow stronger.

S: Murder your wife. Murder your wife. Murder your wife.

SPIEGEL: That's the terrible irony of this condition. It's exactly a person's conscientiousness that makes the horrible thoughts return again and again and again. That's where the knife comes in. Slowly over time, Corboy encourages patients like us to take the knife, hold it to his throat. Together they'll sit there for 10 minutes, for 15. Basically, it's a form of evidence - really compelling evidence - that even though S has the opportunity to kill, he's not going to do it. And therefore, he's forced to confront the reality that his thoughts should not be taken seriously.

CORBOY: They are not in any way, shape or form a reflection of that person's character.

SPIEGEL: This kind of therapy is called exposure therapy. You progressively expose people to exactly the thing that they fear most. And it should be incredibly effective for OCD. That's why Corboy doesn't just have knives in his office, he has a whole cabinet devoted to different implements of destruction.

CORBOY: If somebody's afraid of hammering someone to death, we can give them this - a mallet.

SPIEGEL: There's a screwdriver.

CORBOY: A meat cleaver.

SPIEGEL: A razor.

CORBOY: Hypodermic needles.

SPIEGEL: Are these, like, poisons here?

CORBOY: Mhm.

SPIEGEL: And then he asks them to hold these things in their hands, to touch them...

CORBOY: Bigger, sharper knives.

SPIEGEL: ...And use them over and over again right there with him.

CORBOY: I had them sharpened recently if you'd like to feel the edge.

SPIEGEL: OK.

So that ultimately, they can learn to see their thoughts in a new way.

CORBOY: So you can feel that it's...

SPIEGEL: Now, Corboy actually had me do this myself - hold a knife to his throat in his office.

So I just take this knife and I - where do you want me to put...

CORBOY: Put it right to my neck, wherever you can find my jugular or any other vein.

SPIEGEL: I took the blade right up to the skin on his throat.

Is this OK?

CORBOY: Yeah, you were fine the other way.

SPIEGEL: And even for me - someone who doesn't actually struggle with this stuff - it was frightening to be so close to someone's jugular.

Am I hurting you?

CORBOY: No.

SPIEGEL: Are you sure?

CORBOY: I can feel it, but it's not hurting.

SPIEGEL: OK.

The skin there is so thin. S, at first, couldn't even hold a knife. He had to work up to it slowly. First, he was told to just conjure up the worst images he could think of.

S: A face that was mutilated, harming a child, killing a dog.

SPIEGEL: And he was told to just sit there thinking about them.

S: I would try to hold that in my mind - that image, harming a child - until it lost its meaning, and I wasn't scared of doing that.

SPIEGEL: Then he was told to step it up a notch.

S: Put my hands around the dog's neck.

SPIEGEL: He was told to go sit with his dog with his hands around his dog's neck.

S: And bring up the image of strangling my dog to death.

SPIEGEL: He said at first it was scary.

S: You know, that slim chance - what if my hands clenched up, and I did strangle my dog?

SPIEGEL: But over time...

S: A couple minutes, I realized that even with my hands around his neck, I wouldn't do it. And so after that, that thought just - if it popped in my mind, I was able to laugh it off.

SPIEGEL: (Laughter).

And finally, the biggie.

S: My wife.

MILLER: He had to take a knife to his wife.

S: Yeah.

UNIDENTIFIED WOMAN #7: We were standing there in the kitchen. It was dusk. It was, you know, summertime, and I was about to prepare dinner.

SPIEGEL: And he took out a knife from a butcher block.

UNIDENTIFIED WOMAN #7: You know, it was a big, long-bladed knife, yeah. And, you know, it took him a while to actually hold it and, you know, pick it up and hold it near me.

SPIEGEL: But eventually he came up close to her.

S: I held the knife in my hand, brought on the image of stabbing her.

UNIDENTIFIED WOMAN #7: I could tell he was nervous.

S: Murder your wife. Murder your wife. Murder your wife.

UNIDENTIFIED WOMAN #7: He had the knife near my arm.

SPIEGEL: And he's trying as best he can to hold onto that thought.

S: Murder your wife.

And just face it head on.

SPIEGEL: And after a few minutes, he noticed his heart wasn't beating so fast.

S: I realized that I was not capable or was not going to do it.

UNIDENTIFIED WOMAN #7: So that was it.

SPIEGEL: He said, in time...

S: Four months.

SPIEGEL: ...The more he sat with the thoughts...

S: Thousands and thousands of different disturbing thoughts.

SPIEGEL: ...The more they began to ease up.

S: To where I felt a significant improvement and could actually live again, I would say.

SPIEGEL: And, like, when was the moment that you knew that you were free?

S: I'll never be free.

UNIDENTIFIED GIRL #3: Daddy, Daddy.

SPIEGEL: Do you want to go get it? Sure.

He says he still has the thoughts.

S: I still have the thoughts. I still have the thoughts, you know, about my wife.

Hey, you.

Even my daughter.

What are you doing?

SPIEGEL: And is much as he hates them...

S: Who would want to have that?

SPIEGEL: ...Now he trusts - really trusts - that he doesn't have to listen to them.

S: What are you watching - "Rella"? Watching "Cinderella"?

I just let it be there, and then, you know, it eventually just dissipates and goes away.

Daddy's going to go back in the room, OK? Sound good? OK.

SPIEGEL: He said, there was a moment when he knew that things were going to be OK.

S: Want to go on the swings?

SPIEGEL: But it didn't look anything like what he thought peace might look like. He's never been returned to that Eden from before the thoughts broke out.

S: Yeah. I remember my wife and I going to the beach with our dog, and we were watching the sunset, sitting on the dunes, looking out on the water and the sunset. And boom - a stabbing thought popped through my mind.

SPIEGEL: But then he noticed something strange. The thought floated away.

S: It was just another thought.

UNIDENTIFIED WOMAN #8: I'll always be alone. No one will love me.

S: This flicker of an impulse to just throw myself down the tracks.

UNIDENTIFIED GIRL #4: I'm thinking about colors.

UNIDENTIFIED WOMAN #3: I was thinking about my sister. I was thinking how I could help her.

S: Throwing myself off things.

UNIDENTIFIED WOMAN #2: I'm stupid.

UNIDENTIFIED WOMAN #9: There's going to be a phone call in the night.

SPIEGEL: INVISIBILIA will return in a moment.

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